Outcomes of neoadjuvant and definitive CROSS (carboplatin and paclitaxel chemoradiotherapy) in oesophageal cancer.
Authors: Samreen Iqbal, Victoria Atkinson, Melissa Arneil, Vladimir Andelkovic, Kate Elizabeth Roberts
Journal: Journal of Clinical Oncology (2022)

e16033 Background: This is a retrospective analysis of outcomes in patients with oesophageal cancer treated with either neoadjuvant or definitive CROSS chemoradiotherapy (CRT) at the Princess Alexandra Hospital between 2016-2020. Methods: Data was collected from a single centre using the electronic medical records system. Patient demographics, oesophageal cancer characteristics, treatments and outcomes were recorded. Results: 90 patients were identified–75% were male and the average age at diagnosis was 64 years. Higher tumour grade, nodal stage or grade of oesophageal cancer was associated with lower average overall survival (OS). 68% had oesophageal adenocarcinoma (Adeno) and 31% had oesophageal squamous cell carcinoma (SCC). Of those with Adeno, 69% received neoadjuvant CROSS and 31% definitive CROSS. 32% of those with SCC received neoadjuvant CROSS with 64% receiving definitive CROSS therapy. Routine adjuvant chemotherapy was not delivered post CRT. 81% of those with Adeno treated with neoadjuvant CROSS proceeded to surgery compared to 100% of those with SCC treated similarly. Only 19% of patients did not complete CRT however 67% of patients experienced some toxicity and 43% required hospitalisation during the course of therapy. Average weight loss during therapy was 6.4kg. 27% of patients required enteral nutrition and they had a lower OS (20 months) compared to those that did not require nutritional support (25 months). Of those with Adeno, 50% of patients who received neoadjuvant CROSS experienced relapse compared to 74% in patients who received definitive CROSS. For the SCC cohort, 22% of those who received neoadjuvant CROSS relapsed compared to 44% who received definitive CROSS. Average time to relapse (from end of CRT) was greatest for those with SCC receiving neoadjuvant CROSS (16 months) and worst for those with SCC receiving definitive CROSS (7 months). Average OS for patients with Adeno who received definitive CROSS was 18 months compared to 27 months for those who received neoadjuvant CROSS. For patients with SCC, the average OS for those who received definitive CROSS was 18 months compared to 29 months for those treated with neoadjuvant CROSS. Of those with Adeno, 63% of those treated with definitive CROSS and 38% of those treated with neoadjuvant CROSS died secondary to their disease. For patients with SCC, 44% of those treated with definitive CROSS died whilst everyone who received neoadjuvant CROSS was alive at study conclusion. Conclusions: The best outcomes were seen in patients with SCC treated with neoadjuvant CROSS; this group had the highest OS (29 months), the lowest relapse rate (22%) and all patients were alive at the end of the study. The pivotal CROSS study by Shapiro et al. also demonstrated better outcomes in the SCC cohort, with this analysis further comparing definitive vs neoadjuvant CROSS. A limitation however is the comparatively shorter follow up period.